The latest CMS proposed policy changes to Medicare Advantage and Part D plans include new benefit flexibilities and federal oversight to manage opioid patient safety risks.

February 02, 2018 - CMS has released the second part of its proposed Medicare Advantage (MA) and Medicare Part D changes, which include administrative upgrades to assist with combating the nation’s the opioid crisis and allowing payers to incorporate supplemental benefits into health plans.

The proposed changes redefine health-related supplemental benefits by allowing payers to cover services including non-skilled in-home support, portable wheelchair ramps, and other assistive devices and modifications when patients need them. These benefits are intended to reduce the impact of physical injuries and prevent avoidable ED utilization.

Additionally, CMS said that they are incorporating additional federal oversight of Part D plans to reduce beneficiaries’ likelihood of developing dependence on prescribed opioids.

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CMS proposed the change based on its success in using an overutilization monitoring system (OMS) to lower opioid abuse risks. The proposed changes would also enhance the OMS to flag beneficiaries that use other high-risk substances in combination with opioids.

Health plans would additionally receive new tools from CMS to identify and manage the prevalence of chronic diseases among beneficiary populations.

CMS believes the changes can help further enhance beneficiary experience within a growing MA market. The agency found that roughly one-third of Medicare beneficiaries are enrolled in an MA health plan.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”

The agency released an accompanying fact sheet that shows how the 2019 Medicare Advantage and Part D Advance Notice Part II would change MA payment rates, affect Star Ratings, and benefit flexibilities for MA plans.

According to CMS, the proposed changes would increase federal payments by 4.35 percent and increases average change in revenue by 1.84 percent. The changes in payments and revenues are based on better use of encounter data and new coding patterns to calculate risk adjustment models.

The proposed changes would also cause a very small decrease in overall Star Ratings of Medicare plans.

Star Ratings are only expected to lower by 0.2 percent because the agency proposed new quality measures that would re-determine star ratings. For 2019, CMS wants to include a “Statin Use in Persons with Diabetes” measure for Part D plans and a “Statin Therapy for Patients with Cardiovascular Disease” measure in Part C plans.

The call letter includes previous changes that allow MA plans flexibilities in cost-sharing design which would allow payers to either lower or increase cost-sharing amounts for certain conditions.

Stakeholders can submit comments about the second part of the draft letter until March 5, 2018. A final rate announcement and call letter will be published on April 2, 2018.